PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Supplemental Notice to WSR 08-15-129.
Preproposal statement of inquiry was filed as WSR 07-03-057.
Title of Rule and Other Identifying Information: The department is creating and amending sections in chapter 388-537 WAC: Amending WAC 388-537-0100 School–based healthcare services for children in special education -- Purpose; and new sections WAC 388-537-0200 School-based healthcare services for children in special education -- Definitions, 388-537-0300 School-based healthcare services for children in special education -- Client eligibility, 388-537-0350 School-based healthcare services for children in special education -- Provider qualifications, 388-537-0400 School-based healthcare services for children in special education -- Covered services, 388-537-0500 School-based healthcare services for children in special education -- Noncovered services, 388-537-0600 School-based healthcare services for children in special education -- School district requirements for billing and payment, 388-537-0700 School-based healthcare services for children in special education, and 388-537-0800 School-based healthcare services for children in special education -- Program monitoring/audits.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on October 21, 2008, at 10:00 a.m.
Date of Intended Adoption: Not sooner than October 22, 2008.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on October 21, 2008.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by October 14, 2008, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Rules were originally proposed as WSR 08-15-129 and a public hearing was held on August 26, 2008. As a result of additional comments received, the department makes revisions to the proposed rules to include:
| • | Expanding the definitions in WAC 388-537-0200, and |
| • | Naming the appropriate documentation the provider is required to maintain on site for program audits and monitoring in WAC 388-537-0350 and 388-537-0800. |
Reasons Supporting Proposal: To ensure continuing federal participation in the state's payments for school-based healthcare services.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.500.
Statute Being Implemented: RCW 74.09.500, 42 C.F.R. 440.110.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, health and recovery services, governmental.
Name of Agency Personnel Responsible for Drafting: Jonell Blatt, HRSA, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1571; Implementation and Enforcement: Chris Bess, HRSA, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1668.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department is not required to prepare a small business economic impact statement when it adopts rules that simply conform to and/or comply with a federal statute or regulation. Instead, according to RCW 19.85.061, the following statement applies: 42 C.F.R. 440.110 is the specific federal statute or regulation under which the rule is conforming; and according to RCW 74.04.015 programs administered by the department must conform to federal requirements with respect to eligibility for the receipt of federal grants or funds.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Jonell Blatt, P.O. Box 45504, Olympia, WA 45504 [98504]-5504, phone (360) 866-3545, fax (360) 586-9727, e-mail blattj@dshs.wa.gov.
Note: The cost-benefit analysis has been revised to reflect the changes in this supplemental proposal.
September 11, 2008
Stephanie E. Schiller
Rules Coordinator
4004.3(2) To qualify for payment under this section, the medical services must be provided:
(a) By the school district or the ESD; and
(b) To the eligible special education student as part of the student's individualized education program (IEP) or individualized family service plan (IFSP).
(3) To qualify for payment under this section, the medical services must be provided by one of the following service providers:
(a) A qualified Medicaid provider as described under WAC 388-502-0010;
(b) A psychologist, licensed by the state of Washington or granted an educational staff associate (ESA) certificate by the state board of education;
(c) A school guidance counselor, or a school social worker, who has been granted an ESA certificate by the state board of education; or
(d) A person trained and supervised by any of the following:
(i) A licensed registered nurse;
(ii) A licensed physical therapist or physiatrist;
(iii) A licensed occupational therapist; or
(iv) A speech pathologist or audiologist who:
(A) Has been granted a certificate of clinical competence by the American speech, hearing, and language association;
(B) Is a person who completed the equivalent educational and work experience necessary for such a certificate; or
(C) Is a person who has completed the academic program and is acquiring supervised work experience to qualify for the certificate.
(4) Student service recommendations and referrals must be updated at least annually.
(5) The student does not need a provider prescription to receive services described under this section.
(6) MAA pays for school-based medical services according to the department-established rate or the billed amount, whichever is lower.
(7) MAA does not pay individual school practitioners who provide school-based medical services.
(8) For medical services billed to Medicaid, school districts or ESD, must pursue third-party resources)) The department of social and health services (DSHS) pays school districts for school-based healthcare services provided to children in special education in accordance with the individuals with disabilities education act (IDEA). The services must:
(a) Address the physical and/or mental disabilities of a child;
(b) Be prescribed or recommended by a physician or other qualified healthcare provider within his or her scope of practice under state law; and
(c) Be included in the child's individualized education program (IEP).
[Statutory Authority: RCW 74.08.090. 01-02-076, § 388-537-0100, filed 12/29/00, effective 1/29/01. Statutory Authority: RCW 74.04.050 and 74.08.090. 00-01-088, § 388-537-0100, filed 12/14/99, effective 1/14/00.]
"Assessment" - For purposes of this chapter an assessment is made-up of tests given to an individual child by qualified professionals to evaluate whether a child is determined to be a child with a disability and in need of special education and related services. Assessments are a part of the evaluation and re-evaluation processes.
"Child with a disability" - For purposes of this chapter, a child with a disability means a child evaluated and determined to need special education and related services because of a disability in one or more of the following eligibility categories:
• Mental retardation;
• Hearing impairment (including deafness);
• Speech or language impairment;
• Serious emotional disturbance (emotional behavioral disability);
• Orthopedic impairment;
• Autism;
• Traumatic brain injury;
• Other health impairment;
• Specific learning disability;
• Deaf/blindness;
• Multiple disabilities; or
• A developmental delay for children ages three through nine, with an adverse educational impact, the results of which require special education and related direct services.
"Direct healthcare services" - Services provided directly to a child either one-on-one or in a group setting.
"Educational staff associate (ESA) certification" - The ESA certificate is an official document that attests to minimum prerequisites of age, moral character/fitness, education, experience, competence, and preparation program, depending on the certificate types. The ESA certification is required to serve in a Washington public school.
"Evaluation" - Procedures used according to WAC 392-172A-03005 through 392-172A-03080 to determine whether a student has a disability, and the nature and extent of the special education and related services needed.
"Fee-for-service" - For the purpose of this section, the general payment method the department uses to reimburse providers for covered medical services provided to medical assistance clients when those services are not covered under the department's managed care plans or state children's health insurance program (SCHIP).
"Individuals with disabilities education act (IDEA)" - The IDEA is a United States federal law that governs how states and public agencies provide early intervention, special education, and related services to children with disabilities. It addresses the educational needs of children with disabilities from birth to age of twenty-one.
"Individualized education program (IEP)" - A written statement of an educational program for a student eligible for special education. (See WAC 392-172A-03090 through 392-172A-03135.)
"Qualified healthcare provider" - See WAC 388-537-0350.
"Re-evaluation" - Procedures used to determine whether a student continues to be in need of special education and related services. (See WAC 392-172A-03015.)
"Related services" - Developmental, corrective, and other supportive services required to assist an eligible student to benefit from special education. For purposes of this program, related services include: physical therapy, occupational therapy, speech-language therapy, audiology services, psychological assessments, counseling, and nursing services.
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(1) Audiology services delivered by:
(a) A licensed audiologist; or
(b) A school-based audiologist who:
(i) Meets the education and work experience necessary for a state professional license;
(ii) Holds a valid school audiologist educational staff associate certificate; and
(iii) Limits their audiology services to the school setting.
(2) Counseling services delivered by:
(a) A licensed independent social worker;
(b) A licensed advanced social worker;
(c) A licensed mental health counselor; or
(d) A school-based social worker or mental health counselor who:
(i) Meets the education and work experience necessary for a state professional license;
(ii) Holds a valid school social worker or school counselor educational staff associate certificate; and
(iii) Limits their counseling services to the school setting.
(3) Nursing services delivered by:
(a) A licensed registered nurse;
(b) A licensed practical nurse; or
(c) A noncredentialed school employee who is delegated certain limited healthcare tasks by a registered nurse and, trained and supervised according to professional practice standards.
(4) Occupational therapy services delivered by:
(a) A licensed occupational therapist; or
(b) A certified occupational therapy assistant supervised by a licensed occupational therapist in accordance with professional practice standards.
(5) Physical therapy services delivered by:
(a) A licensed physical therapist; or
(b) A licensed physical therapist assistant supervised by a licensed physical therapist in accordance with professional practice standards.
(6) Psychological services delivered by:
(a) A licensed psychologist; or
(b) A school-based psychologist who:
(i) Holds a masters degree in school psychology;
(ii) Holds a valid school psychologist educational staff associate certificate; and
(iii) Limits their psychological services to the school setting.
(c) A school-based psychologist who:
(i) Holds a doctoral degree in psychology;
(ii) Holds a valid school psychologist educational staff associate certificate; and
(iii) Limits their psychological services to the school setting.
(7) Speech therapy services delivered by:
(a) A licensed speech-language pathologist;
(b) A speech-language pathology assistant, who has graduated from a speech-language pathology assistant program, and is supervised by a speech-language pathologist with a certificate of clinical competence (CCC) in accordance with professional practice standards; or
(c) A school-based speech-language pathologist who:
(i) Meets the education and work experience necessary for a state professional license;
(ii) Holds a valid school speech-language pathologist educational staff associate certificate; and
(iii) Limits their speech therapy services to the school setting.
(8) For services provided under the supervision of a physical therapist, occupational therapist or speech-language pathologist the following requirements apply:
(a) The nature, frequency and length of the supervision must be provided in accordance with professional practice standards and adequate to assure the child receives quality therapy services.
(b) At a minimum, supervision must be one-on-one communication between the supervisor and the supervised professional.
(c) Documentation of supervisory activities must be on record and available to the department upon request.
(9) It is the responsibility of the school district to assure providers meet the professional requirements necessary for reimbursement.
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(1) Evaluations, when the child is determined to be a child with a disability and in need of special education and related services;
(2) Direct healthcare services including:
(a) Audiology;
(b) Counseling;
(c) Nursing;
(d) Occupational therapy;
(e) Physical therapy;
(f) Psychological assessments;
(g) Speech-language therapy.
(3) Re-evaluations, to determine whether the child continues to need special education and related services.
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(1) Attending meetings;
(2) Charting;
(3) Equipment preparation;
(4) Instructional assistant contact;
(5) Parent consultation;
(6) Parent contact;
(7) Planning;
(8) Preparing and sending correspondence to parents or other professionals;
(9) Professional consultation;
(10) Report writing;
(11) Review of records;
(12) Set-up;
(13) Teacher contact;
(14) Test interpretation;
(15) Travel; and
(16) Observation.
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(1) Have a current, signed core provider agreement with the department;
(2) Meet the applicable requirements in chapter 388-502 WAC; and
(3) Bill according to the department's published school-based healthcare services billing instructions.
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(a) Professional assessment reports;
(b) Evaluation and re-evaluation reports;
(c) Individualized education program (IEP); and
(d) Treatment notes for each date of service the provider billed to the department.
(2) All provider licenses and other credentials must be current and on file with the school district and available for review upon request.
(3) All records must be easily and readily available to the department upon request.
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(2) The department monitors school-based healthcare services as established by the school-based healthcare services program manager and in compliance with the department's monitoring policy and plan.
(3) The department conducts audits of school-based healthcare services in accordance with chapter 388-502A WAC.
(4) The department authority to conduct audits and recover overpayments is found in RCW 74.09.200, 74.09.220 and 74.09.290.
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